Healthcare Provider Details

I. General information

NPI: 1962658450
Provider Name (Legal Business Name): IRIS PEREZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2008
Last Update Date: 08/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1038 E CHESTNUT AVE
VINELAND NJ
08360-5800
US

IV. Provider business mailing address

PO BOX 597
BRIDGETON NJ
08302-0433
US

V. Phone/Fax

Practice location:
  • Phone: 856-691-3300
  • Fax: 856-794-7183
Mailing address:
  • Phone: 856-451-4700
  • Fax: 856-794-7183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number26NN03219300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: